Comanche Nation to Open Health Clinic
Comanche Nation will open its Red Berry health system clinic in April, and the team guiding the process is Vestra Tribal Care, which applied for a Request for Proposal.
Dr. Joseph Nicholas Heinen is a family practice physician who has worked with tribes, such as Coushatta, for 15 years.
He said they won the RFP by having a consultant role over someone who will be operating.
Heinen said it’s usually a two to three-year process, and tribes have to pull shares from Indian Health Service (IHS).
“And so that's also what's different about our model. Like I said, normally you pull all those shares, take all that money, you know, build [an] architect design, build it, you know, build a big building, and this takes, in higher status, takes two, three, sometimes four years,” he said. “With this model, where we did not pull those shares, we're really relying on third-party revenue, and that's your Medicaid, Medicare, private insurance to kind of fund the clinic. And so…by doing that and finding a practice that's actually existing, which of course we vetted all the quality and their scores and things like that, then that shortens the process down to, I mean, we're [going to] have this open within eight months of signing the contract versus two, three, four years.”
Johnathen Worth, who is Muscogee Creek, Cherokee and an Air Force Veteran who worked with IHS in Washington, D.C., is the principal of Vestra Tribal Care.
“A lot of people have heard, you know, how the tribes interact with IHS, but for each little, like the Lawton Hospital Service, there's several tribes in the area,” he said. “So, each tribe has a little piece of the pie when it comes to funding, and all that money goes to the hospital to run services for that…Generally, when the tribes say we want to create our own health system, they take their whole piece. And for Comanche Nation, that's a quarter of the hospital's budget, so that would be devastating to the hospital to do that. Comanche did not want to do that. Comanche wanted to still support them fully, but also start down this road. Now, if you think about that from a non-Comanche standpoint, if the other tribes, say all the other tribes, pull out and create their own health system, now they don't have enough money to keep it open for Comanche. So, if Comanche is not proactive now in creating a health system that could, in the future, keep that safety net, should anything happen over at the hospital, downsizing, moving, closures, things like that, they would be behind in trying to create a clinic system.”
Worth said most tribal members have some sort of insurance, either Medicare, Medicaid or SoonerCare.
“They have insurance through their companies. A lot of times, if you work for a company, you may have insurance. And that allows you to go out and see your doctors, get your prescriptions, get services done through your insurance, and then the insurance pays those doctors or pharmacies or labs,” he said. “Currently, if you have insurance and you go to the Indian Health Service, the Indian Health Service will bill the insurance and get reimbursed for those services. So, they have the federal funding, plus they do get reimbursed for people who have insurance. So, if a tribal member were to come here, they still get their federal funding to keep the hospital running. But the patient being seen here, we would bill their insurance, and we would get that insurance payment amount through the third-party revenue that normally would go to IHS if they were seen over there. So that's one way we were building this, to use those alternative funds to operate the clinic and pay for operations without taking money from services or money from IHS. And so, it's very important if a citizen thinks about ways they can help the tribe with this expansion. Having some sort of coverage when they come here to use the clinic is helpful, whether that's Medicaid, whether it's through the Health Exchange. And we have many options to get people on coverage if they don't have coverage, for most of the time zero cost to the patient. But it is a way that they can help support the clinic through having that kind of coverage. And then when the pharmacy opens up, same thing with pharmacy, insurance generally pays for pharmaceuticals, things like that. So that's going to be the goal of creating the process of how to fund the clinic without coming from the tribe having to pay it out of pocket.”
Worth said that if someone doesn’t have insurance, they will have someone at the clinic to help them sign up, but they do have a plan in place for those who are not insured.
“Because it's a tribal clinic, there are some differences in how people are covered. So, tribal citizens and natives that are covered under IHS generally, there is funding available if they're uninsured to help cover some of the costs,” he said. “And there also are people who are eligible that already have insurance that would help with a third-party. Generally, the way we look at it is the patients, as we're building out the programs, the reason right now we're starting out with the pediatrics and primary family medicine, is that we are able to look at the services as a whole and be able to know how much the average patient would cost through using the clinic. And we've balanced that with the funding received from IHS as well as what we expect insurance-wise to do.”
Heinen said his role is for the medical staff.
“Really, I handle more of the medical side, obviously being the family practice physician. So, training providers, making sure their quality is up to date and where they need to be,” he said. “Compliance, really just making sure all the clinical programs and protocols are being operated correctly. Especially taking into consideration being in a tribal clinic. There's a lot of different protocols and regulations and things like that that need to be handled better differently than you would in an independent clinic, let's say, or a hospital clinic.”
Heinen said the focus is on bringing culture into medical care.
“I started out 15 years ago in tribal health care. That was a fairly large casino. They had about 5,000 lives that were under their health plan. And you can learn a lot about people and their culture and their situations whenever you're dealing with a self-funded health plan. Which basically means the tribe is paying for all their own health insurance for not only their own members but for all their employees. And because it was such a large health system, we were able to really take deeper dives into their health,” he said. “And so, from that, we were able to generate some of the higher-quality standards and metrics. And Louisiana is where we started with them. And so that was really that learning experience earlier in our career, you know, 10, 15 years ago, really launched us into where we are today. Because the beautiful thing with health care is, which you don't see in other industries, the higher the quality, typically the lower the cost. And that's how we kind of started it. And from there we took that and said, ‘Okay, well if we can do that in a casino type employment setting and then, you know, already dealing with, you know, so many of the natives from that tribe that we're dealing with, you know, we can do that for what we call 638 clinic or starting the tribe's own health system.’ And so that's what we're bringing here to Comanche Nation.”
While Worth will lead administrative duties.
“Working with the tribe to make sure that we thoughtfully plan out a health system that is going to be sustainable and effective for the people. And given the challenges with health care, providing direct health care with tribal citizens, there's a lot of challenges on the back-end administration and to make sure that the costs are controlled and not becoming a burden for the tribe,” he said. “That the operations are running smoothly and according to the tribal laws as well as the federal requirements. To make sure that the treaty rights from the federal government are acknowledged, and that includes funding for the clinic. And also making sure the access is there for citizens from urgent care all the way up to complex medical issues.”
Worth said the clinic will allow patients to have continued access to care.
“The tribe's not looking to take on everything from the IHS, but they're looking to provide extra access to care. Specifically, in areas that IHS may be booked up on. So, a lot of people have mentioned long lines, having to schedule appointments weeks or months out, referral and contract health services needing some extra wait time,” he said. “And we're looking to help cut down on some of that and help provide some support. But with that, there has to be a balance between people will still use the Indian Health Service, people will still access that, have access to that. And making sure that we're providing equal to or better care in our case. Our goal is to provide more culturally competent to the Comanche Nation care.”
Comanche Nation is handling the building, training, care and supplies.
“It's very overwhelming. So that's our main relationship is to help them create and start to run that program. And then as time goes by, as [we’re] able to hire more staff, as everything, the patients start coming in, we will slowly be working with Comanche Nation to train staff both on the front end, the providers and the nurses and the staff, as well as the back end. There's a lot of functions that go into between HR, and finance, and security, and IT and there's a lot of stuff going on. So, there's a lot of training back and forth that Comanche wasn't already staffed up on. And so, we have a lot of work to get to that point.”
Heinen said the goal is for the tribe to take over the operation and eventually expand.
“So, in this clinic, we will be putting in a pharmacy. It'll either be toward the end of this year or early next year. One of the big points in improving quality is it's not just access to your provider; it's also access to medicines. And not only just access to medicines, but making sure they're either affordable or available. So one of our things that we deal with, let's say if you're dealing with an IHS clinic, they're very limited on what types of meds they can have. So, let's say if you're a diabetic, you may only get these three, four different classes of meds whenever we're able to put the Comanche Nation Pharmacy in. We have access through programs that IHS doesn't have access to because of Comanche being a sovereign nation; they have access to these programs. So, we're able to open up this formula to a lot of newer, more advanced medications that we can get for very cheap. And so that also increase to improve quality and outcomes. Because as a provider, if I can prescribe a medicine that's, you know, let's say once a week for a diabetic injection versus something that might be twice a day, they're more likely to take that med and be more compliant with it. So having that pharmacy on site where they can pick it up, or maybe, you know, if we need to ship it to them, we can. And so, we're really excited to get that program off the ground.”
Worth said the Comanche Nation is looking into expansions.
“This is our first, our first dipping our toe in the water to get everything going on the beginning level. But stage one is very, very small in the big plan of what the health system would look like. So, finding a building that also had enough room to expand and to be flexible in the expansion, depending on what the needs are of the Comanche members. So, like I said earlier, each tribe's unique and the members are unique. So, if we find over time that it's better that we offer a certain service or specialty that maybe isn't available at the IHS Lawton Hospital, or that we're seeing that's more prevalent here than another tribe, this gives us the opportunity to expand and be more flexible in that expansion. So that was a big bonus for this building.”
Red Berry will be a tribal entity in collaboration with Vestra Tribal Care.
The clinic will also work with IHS and area hospitals for referrals.
Services will be for pediatric and adult patients.
The clinic is located at 6403 W Gore in Lawton, Oklahoma.
